Provider Demographics
NPI:1366594426
Name:LEVRINI, MICHAEL GEORGE (DHSC PT ECS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:LEVRINI
Suffix:
Gender:M
Credentials:DHSC PT ECS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11670 BENNINGTON WOODS RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1610
Mailing Address - Country:US
Mailing Address - Phone:703-787-8434
Mailing Address - Fax:703-787-8434
Practice Address - Street 1:11670 BENNINGTON WOODS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1610
Practice Address - Country:US
Practice Address - Phone:703-787-8434
Practice Address - Fax:703-787-8434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050055142251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010027268Medicaid
VA259143OtherANTHEM BC BS PROV NUMBER
VA299977OtherMAMSI PROVIDER #
VA7740445OtherAETNA PROVIDER NUMBER
VA010027268Medicaid